Aggressive hepatic resection for patients with pyogenic liver abscess and APACHE II score ≥15

• Published in: The American journal of surgery Vol. 196; no. 3; pp. 346 - 350
• Main Authors: Hsieh, Huan-Fa, M.D, Chen, Teng-Wei, M.D, Yu, Chih-Yung, M.D, Wang, Ning-Chi, M.D, Chu, Heng-Cheng, M.D, Shih, Ming-Liang, M.D, Yu, Jyh-Cherng, M.D, Hsieh, Chung-Bao, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2008; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; APACHE; APACHE II; Biological and medical sciences; Female; General aspects; Hepatectomy - methods; Hepatic resection; Hospitalization; Hospitals; Humans; Infections; Liver Abscess, Pyogenic - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Mortality; Patients; Pyogenic liver abscess; Respiratory distress syndrome; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Taiwan; APACHE II; Pyogenic liver abscess; Hepatic resection; Human; Hepatic disease; Patient; Hepatectomy; Medicine; Score; Treatment; Surgery; Digestive diseases; Liver abscess; High malignancy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.09.051

Abstract Background Most liver abscesses resolve after antimicrobial therapy or percutaneous tube drainage (PD). The aim of this study was to evaluate the results of hepatic resection (HR) for patients with pyogenic liver abscesses and an Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥15. Methods We compared the clinical outcomes of 81 patients with APACHE II scores ≥15 undergoing PD and/or HR. Results The failure rate (3 of 65) and double-treatment rate (32 of 65) in the PD group were significantly higher than in the HR group (3 of 35 vs 0 of 35; P = .0002). The mortality rate in the PD group was significantly higher than the other 2 groups (14 of 46 vs 2 of 19 and 1 of 16; P = .038). The length of hospital stay was significantly shorter and antibiotic use less in the HR group than in the PD group ( P < .05). Conclusions Aggressive HR for patients with liver abscesses and APACHE II scores ≥15 produced better clinical outcomes.